On March 4, a 69-year-old male patient was Riverside & University of Virginia Radiosurgery Center's 1,000(th) patient to be treated since the facility opened in 2006. Clinicians used their Leksell Gamma Knife® 4C to treat a metastatic melanoma in the patient's brain. Coincidentally, the patient also had undergone radiosurgery earlier for lung and chest wall nodules, benefiting that time by Riverside's Elekta Synergy® S. Whether the disease is intra- or extra-cranial, Riverside can offer patients a highly targeted radiosurgical solution.

Radiosurgery is a form of radiation therapy that emphasizes higher than typical radiation doses applied with extreme accuracy and over a very limited number of therapy sessions. Gamma Knife surgery is accomplished nearly exclusively in one treatment, while linear accelerator-based radiosurgery involves one to five sessions or "fractions." Riverside worked with the University of Virginia (Charlottesville, Va.) to establish the Riverside facility, starting Gamma Knife treatments in June 2006 and Elekta Synergy S treatments in May 2007.

"Some centers economize by acquiring a single general system to perform radiosurgery for all targets in the head and body," says Riverside radiation oncologist Ronald Kersh, M.D. "However, if you're serious about attaining the highest radiosurgical accuracy possible, you need to consider dedicated treatment systems. Leksell Gamma Knife is viewed as the gold standard for accuracy in treating intra-cranial targets, such as metastases and functional disorders. Similarly, Elekta Synergy S not only provides exceptional accuracy for extracranial targets, but it also complements Gamma Knife by enabling treatment of larger intra-cranial lesions located in critical areas that would benefit from a multi-fraction approach, such as large meningiomas or optic nerve tumors."

Need for body radiosurgery evident from the start
Riverside's region in eastern Virginia has demonstrated a high demand for radiosurgical services, with each year's patient volume exceeding the last and the third year seeing an explosion in referrals, Dr. Kersh says.

"Our Synergy S volume has exceeded expectations, both in terms of volume — which is four to five cases per day — and in variety. We had anticipated mostly spine lesions and some brain tumors that weren't suitable for Gamma Knife surgery, but we are also treating gynecologic indications — such as ovarian cancer — mediastinal-based subcarinal tumors and adrenal gland tumors. Our lung tumor volume has been the biggest surprise — it has surpassed our spine volume. We had no idea how much demand there would be for body radiosurgery."

Riverside clinicians' confidence in their radiosurgical treatment technology and physicists has enabled them to aggressively treat lesions in sensitive areas, particularly the mediastinum, where the esophagus, heart, trachea and paratracheal lymph nodes are located.

"The challenging part is placing the radiation beams to avoid overexposure to the esophagus, trachea and heart," he continues. "We have treated multiple tumors right beside the heart and have seen no cardiac toxicity. I credit our team approach and the excellent work of Riverside physicists in allowing us to do that."

Whether the patient visits Riverside for a brain or body cancer or disorder, Riverside staff prides itself on their collaborative team approach, involving radiation oncologists, neurosurgeons and physicists who consult on all cases. The accumulated expertise and experience from each discipline helps the team arrive at the best possible therapy for the patient.

According to Riverside physicist Martin Richardson, M.S.: "There aren't many dedicated radiosurgery centers where patients are going to see a member of the neurosurgical team, a radiation oncologist, a medical physicist, a nurse and a therapist — all of whom are qualified to treat with Gamma Knife surgery and Elekta Synergy S — when they walk through the door."